Sex Differences in Absolute Cardiovascular Risk Profiles Among Rural Midlife and Elderly Kenyans: Influence of Obesity, Physical Activity, Smoking, and Blood Pressure Control

Abstract

Background: Cardiovascular disease (CVD) will be the leading cause of mortality in Africa by 2030. Yet, little is known about the key drivers of CVD risk in the region. Objective: To examine the risk factors associated with CVD risk in a sample of rural midlife and elderly Kenyans. Methods: Cross-sectional study design. Data were collected following established protocols and included physical activity (PA), body mass index (BMI), waist circumference, blood pressure (BP), and self-reported medical history. Absolute CVD risk scores [Framingham risk scores (FRS)] were computed using non-lab-based Framingham algorithm. Descriptive and inferential statistics were used to evaluate factors associated with CVD risk scores and related sex-specific differences. Results: The sample (N = 102; mean age 59.8 ± 7.3 years; 57.8% female) was on average highly active (median 8891 steps/day) with 61.8% hypertension prevalence. Females versus males had higher BMI (29.2 vs. 24.8 kg/m²; P < 0.001) and central adiposity (84.8 vs. 18.6%; P < 0.001). However, they had lower systolic BP (129.3 vs. 138.3 mmHg; P = 0.032) and didn't smoke (0.0 vs. 11.6%; P = 0.012). Females also were 6.6 years younger (P < 0.001) and had fewer years of education (P < 0.001) and less PA (P = 0.046). Overall, 34.3% of the sample was at high risk of CVD (FRS ≥20%), but females had lower risk compared with males (median FRS 7.4 vs. 25.0%; P < 0.001). Higher CVD risk was associated with higher education (P < 0.001) and having adequate income (P = 0.048). When considering females separately, none of the sociodemographic characteristics or PA measures were associated with CVD risk, but for males, higher CVD risk was associated with higher education (P = 0.025) and lower PA (P = 0.009). Conclusion: Age, BMI, BP, and smoking partially explain sex differences in CVD risk burden. However, sex differences also exist with males being older with higher education-factors associated with higher CVD risk. More research is needed to examine factors associated with absolute CVD risk in females.

Keywords: blood pressure; cardiovascular disease; global health; obesity; physical activity.